The Pain—and Joy—of Transition

In the New York Times, Andrea Long Chu wrote, “There are no good outcomes in transition.” Many trans women know that isn’t true.

Andrea Long Chu.
Andrea Long Chu. Photo illustration by Slate. Photo courtesy of Andrea Long Chu.

This post is part of Outward, Slate’s home for coverage of LGBTQ life, thought, and culture. Read more here.

“Next Thursday, I will get a vagina,” Andrea Long Chu wrote in Sunday’s New York Times. “This is what I want, but there is no guarantee it will make me happier.” In her incendiary, angrily debated piece, Chu, a trans woman and incisive writer and thinker, uses her own profoundly painful experience of gender dysphoria and transition to contest the notion that transition-related medical care like surgery and hormone therapy should only be provided to people on the basis that it will make them “happier.” Rather, Chu argues, the provision of such care should be based solely on the desire and bodily autonomy of the person in question.

This is a necessary point, and I happen to agree. But along the way, Chu also describes her future vagina as a lifelong “wound” that will “require regular, painful attention to maintain.” She asserts that “people transition because they think it will make them feel better,” adding, “The thing is, this is wrong.” And she concludes, ultimately, that there “are no good outcomes in transition. There are only people, begging to be taken seriously.”

Twitter, perhaps by design, exploded. Within hours, Chu—already considered a provocateur by many in the trans community—had been at once fiercely lambasted and lauded on all sides. Her critics, and I was one to a degree, believe she had used her massive platform to misrepresent transition. Chu responded dismissively: “I don’t want to make generalizations but *some* haters have been known to engage from time to time in what from one perspective might be described as ‘hate,’ ” she tweeted when her piece came online. It didn’t help that conservatives and trans-exclusionary feminists immediately seized on the piece as a data point in their twisted campaign to delegitimize trans rights.

Watching the fray, I felt my heart sink. I disagree, strongly, with Chu’s belief that there are no good outcomes in transition. But certainly there are no good outcomes either in the gladiatorial tone of the criticism she received within the trans community, as a hungry cisgender audience of well-meaning do-gooders and more insidious players looked on, waiting to seize control of the narrative. Moments of political conflict within the trans community catch trans people—especially those of us with a public platform—in a double bind: We are at once compelled to respond, since such conflicts affect our lives and relationships, and also required to be conscious that fighting among one another in public exposes our vulnerabilities at a moment when our rights are under assault. But this is important, so here I am.

As a writer, Chu is often brilliant, and her emotional experience is her own. As with all people, she is entitled to her feelings about her body, and she should be able to express them freely, no matter if they’re inconvenient to anyone’s political agenda. Yet in her piece, she uses sensational language that feeds the lurid interest in trans people’s bodies at the expense of our rights and privacy. And in arguing for her right to transition no matter her uncertainty at the outcome, she largely ignores what we do know about the outcomes of transition for most people. With an audience the size of the New York Times’, that could do real damage.

Chu’s essay smartly analyzes the principles of “beneficence” and “nonmaleficence” that govern health care and its approach to trans people, which can and do allow doctors to deny care to trans people if they deem them unlikely to benefit mentally. She shows how this infantilizes trans people and undermines our bodily autonomy—autonomy being an often deprioritized pillar of biomedical ethics—and argues the current medical approach to trans people fails to overcome our historic disempowerment and humiliation by the medical establishment.

This is all important work, and more broadly, I appreciate that Chu challenges some more ideological corners of the trans community to make room for a diversity of experiences. Her struggles as she transitions are real. She deserves the right to process them. Yet with this freedom comes the responsibility to write thoughtfully and with openness to critique, given the stakes, and she does not always meet that bar. Chu’s intense, provocative language in her piece may reflect her emotional experience, but it also grazes some unfortunate stereotypes of how people talk and write about trans people. Her description of neovaginas as “wounds” is especially suspect, reminiscent of the way that trans women’s bodies have often been held up as at once shocking and titillating. As other trans female writers such as Gwen Benaway have pointed out, framing post-op trans women’s vaginas like this perpetuates the harmful idea that post-op trans women’s bodies are “fake” versions of cis women’s bodies. It also generalizes transition in a way that’s hurtful to post-op trans people and potentially damaging to those considering transition. Most important, it is simply untrue, and a common talking point among trans-exclusionary feminists and others.

For most trans people, myself included, the effects of transition are intensely personal and complex, in the same way that any major life decision is complex. It does carry risk. But in making broad declarations, however personal, it’s essential to consider the scientific knowledge we do have. The medical literature has its own problems, but contemporary work such as the Trans Pulse study of more than 433 trans people solidly shows that mental health outcomes do improve after medical transition for the majority of trans people who want it. Chu barely acknowledges this. In fact, later on Twitter, Chu seemed to dismiss the reliability of research on these outcomes altogether, apparently invalidating the voices of other trans women who have transitioned because “these studies only matter to gatekeepers.” This makes her argument grievously incomplete, not to mention especially vulnerable to manipulation by prominent conservatives like Ben Shapiro and Erick Erickson, who have cited the piece as evidence that trans identity is both a mental disorder and a harmful “ideology.” “The New York Times helpfully reminds us, however unintentionally, that transgenderism is a mental health issue and is not normal,” Erickson wrote gleefully on Twitter.

Transition is a life-altering decision, and with it comes anxiety, pain, fear, and self-criticism. There is frequently also joy, fulfillment, and relief. Trans people who are young, newly transitioning, or otherwise vulnerable have a right to accurate, balanced descriptions of the potential impact of transition on their lives. Chu doesn’t bear that burden alone, but it was careless and arguably dangerous to relegate it to a passing mention in her essay.

In the community of trans women, some people speak of a de facto rule under which we do not criticize fellow trans women in public, which serves us well in an atmosphere that seeks first to demonize trans women and second to turn us against one another. I have broken that rule here, because it feels important to be clear: While Chu is right that transition can be painful and at times disappointing for some trans people, there are good outcomes in transition. Many of us are living them.